Roughly 50 percent of adults will experience a potentially traumatic event such as a car accident, assault, or natural disaster in their lifetime1. However, only roughly 8% will develop distress significant enough to receive a diagnosis of PTSD (post-traumatic stress disorder)2. Therefore, many may experience general anxiety, panic, phobias, depression, and other types of psychological symptoms. While distressing, these symptoms may not fully meet the criteria for a diagnosis of PTSD, panic disorder, social anxiety disorder, major depression, or other anxiety, mood, or trauma-related disorder.
Most evidence-based treatments have been created for individuals whose symptoms do meet the criteria for a diagnosis of a mental health disorder. Less research has focused on how to best treat those who are in distress following a trauma, but with symptoms that are not severe enough to warrant a full diagnosis.
Treatment to Build Resilience
Interventions to prevent the development of chronic mental health problems after trauma may also boost a survivor’s resilience in the aftermath of a traumatic event. Resilience is defined here as “adaptation to the disruption that leads to a higher level of homeostasis” or “successful stress-coping ability.”3 Research suggests that psychological distress following a trauma can put individuals at higher risk of experiencing future traumas4. So it’s important to develop interventions to treat what psychologists may call sub-threshold anxiety, depression, and trauma symptoms to enhance resilience in the face of adversity.
To meet this need, a team of researchers developed “Tailored Cognitive-Behavioral Resilience Training (TCBRT),” a flexible, individualized treatment, delivered in five 90-minute sessions5. TCBRT is based on cognitive behavioral theory, which emphasizes how thoughts, feeling, and behaviors influence each other and are rooted in an individual’s learning history and cultural context. Its goal is to boost resilience, enhance quality of life, and reduce distress by working to modify unhelpful thought, emotional, and behavioral patterns.
In the pilot study of this intervention, the sample size was small but diverse. 57% of the sample identified as African American, and 79% identified as female. These individuals had also experienced diverse traumatic events, such as combat, assault, violent and/or accidental death of a loved one, life-threatening illness, and motor vehicle accident.
Learning How to Build Resilience
The first session focuses on identifying participants’ specific goals, while sessions 2-4 focus on psycho-education related to clients’ goals, skill practice related to goals, and action planning to meet goals in out-of-session time. Session 5 focuses on reviewing clients’ progress and potential barriers to continued actions once treatment ends.
Participants can identify the areas of their lives most affected by the traumatic event and focus their in-session and out-of-session practice in these areas, including: reducing negative thinking habits, improving physical health, increasing positive and meaningful activities, improving interpersonal relationships, managing emotions, decreasing avoidant behaviors, improving problem solving, and enhancing forgiveness.
Results Show Great Promise
On average, study participants were highly satisfied with the treatment, reporting that they found “quite a bit of benefit” from it. Results from pre-treatment to post-treatment indicated that roughly 42-50% of individuals reported significant, reliable changes in their resiliency, anxiety, and quality of life, with perceived resiliency and quality of life increasing, and anxiety decreasing.
At the 2-month follow-up assessment, between 36-54% evidenced reliable change in these life areas. For depression and PTSD symptoms, only 25-33% evidence reliable reductions at post-treatment, but this increased to 40-64% at the 2-month follow-up assessment.
This study shows promising evidence for a resiliency-building intervention based in cognitive-behavioral theory for those with sub-threshold anxiety and trauma-related problems. However, some important limitations should be noted. The pilot study results come from a very small sample size. A larger sample with repeated results will provide more confidence in the effects of this intervention. Also, the study did not control for the impact of time on symptoms, quality of life, and resilience. Some participants may have experienced recovery over time without any intervention.
Looking Forward
One most important contributions of this study is that it frames resilience as a skill that can be learned with support, education, and practice. And it can be improved with effort, rather than a fixed trait that only some individuals possess. Future research studies will need to include a control group to test the effects of this intervention more stringently. Hopefully the promising results of this study will be tested in a larger research trial.
Sources
1-2 – Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048–1060. doi:10.1001/ archpsyc.1995.03950240066012
3 – Connor, K. M., & Davidson, J. R. (2003). Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depression and Anxiety, 18(2), 76-82. doi:10.1002/da.10113
4 – Orcutt, H. K., Erickson, D. J., & Wolfe, J. (2002). A prospective analysis of trauma exposure: The mediating role of PTSD symptomatology. Journal of Traumatic Stress, 15, 259&–266. doi:10.1023/A:1015215630493
5 – Zalta, A. K., Tirone, V., Siedjak, J., Boley, R. A., Vechiu, C., Pollack, M. H., & Hobfoll, S. E. (2016). A pilot study of tailored cognitive–behavioral resilience training for trauma survivors with subthreshold distress. Journal of Traumatic Stress, 29(3), 268-272.
Sarah Krill Williston is a PhD Candidate in the Roemer lab at the University of Massachusetts Boston. Sarah’s research primarily focuses on developing strategies to increase mental health literacy and reduce mental health stigma, to empower individuals to more effectively seek evidence-based mental health care for anxiety and trauma-related disorders. In addition, Sarah’s clinical interests include providing evidenced-based treatments (primarily CBT, ABBT) to individuals with mood, anxiety and trauma-related disorders, with a particular interest in working with military families, active duty service members, and veterans.
